Occasionally, we find patients who are apprehensive about being exposed to dental x-rays. That is understandable considering the typical inaccuracy of the sensationalist journalism that sporadically reports on the subject. We offer this comparison to hopefully ease any concerns our patients might have. Feel free to ask as many questions as you would like.

uSv (dose in microsieverts)

0.1 Eating one banana (from the potassium it contains)0.2 Single digital dental x-ray, periapical or bitewing view1.4 Series of 7 digital x-ray bitewing views3.6 Full mouth set of 18 digital x-ray periapical and bitewing views34-68 i-Cat Cone Beam 3D CT-scan (# depends on scan parameters) Cone Beam CT-Scanners
are classified by the FDA as having no to minimal risk.60 Medical frontal or lateral chest x-ray70 One-week background dose at average elevation in the U.S. (78uSv per week if at elevation of Colorado plateau.) Keep in mind that background radiation exposes the entire body, while dental and medical x-rays reach only the parts of our bodies seen the in the x-ray image.70 Additional dose from living in a stone, brick, or concrete building for one year80 Round-trip airplane flight New York to Los Angeles350 Mammogram400 Yearly dose from natural potassium in the body700 Medical x-ray of the abdomen2,000 Medical CT-scan of the head3,600 One-year background dose at average elevation in the U.S.8,000 Medical CT-scan of the chest10,000 Medical CT-scan of the abdomen10,000 Exposure from cooking with natural gas every day (from radon) for one year13,000 Smoking one pack of cigarettes per day for one year16,000 Coronary angiogram50,000 Radiation worker one-year dose limit set by the U.S. National
Council on Radiation Exposure, and the U.S. FDA100,000 Lowest one-year dose clearly linked to increased risk of any cancer

Pregnancy: The American College of Obstetricians and Gynecologists has stated that concerns about possible effects of radiation exposure should not prevent x-rays from being performed during pregnancy. In addition to there being a minimal dose in the x-ray viewing area, x-rays do not go around corners and inadvertently go to other areas. There is absolutely no measurable radiation outside the viewing area, and there is absolutely ZERO biological risk to a developing embryo or fetus.

Our practice gets calls everyday about root canal therapy and it has been an area of great controversy and more and more patients are raising the issue. From my perspective, as a dentist, I am torn between the two polarities, that of those who feel that all root canaled teeth should be removed and root canals should never be performed and those who do not feel that root canaled teeth have any systemic impact. From a neuromuscular and structural perspective I have serious concerns with the removal of teeth that support the jaw and bite. I have treated many patients that had their root canaled teeth removed and now have bite issues. They are trading one set of problems for another. Not to mention the cost. I feel patients should become fully informed about the issue and need to do their own research. I have attached below a link to the OraWellness blog that I feel has a balanced approach to the issues and hopefully can help you make decisions requiring your care.

We continue to provide root canal therapy as a service (we need to be able to chew and support our jaws) but have additional treatment modalities that have been show to improve the ability to clean and disinfect the root canal system of a tooth. These include the scientifically proven PIPS technique (http://www.oralhealthgroup.com/news/pips-improving-your-outcomes-using-laser-activated-irrigation/1002704268/?&er=NA) using our Lightwalker laser (http://www.lightwalkerlaser.com/en/procedures/endodontics/). We also infuse the cleaned out canals with medical grade ozone prior to placing a bio-compatible filling material (http://www.oxygenhealingtherapies.com/).

There are many sites on the internet that address this issue. Of course there is much misinformation as well. As with many medical and dental therapies each individual must do their own due diligence. Please feel free to contact our office if you want more information.

Because we have special training in Dental Sleep Medicine we get frequent referrals and inquiries about what specific appliances we use. Generally, we make the decision as to the particular appliance based on the clinical examination and specific requirements based on the PSG performed at a certified sleep lab and prescribed by a sleep physician. One of the most common oral appliances for sleep apnea treatment is the Somnodent. See the attached link.

We use a modified Somnodent called the LVI Lingualess Somnodent which minimizes impingement on the tongue space. A relatively new appliance called the MicroO2 goes a few steps further and is designed to be minimal in size but must be prescribed by a specially trained Neuromuscular dentist. The key is to find a relaxed jaw position that does not strain the jaw and neck muscles which can compromise the airway. See the attached link below:

We have been providing these appliances recently and are having good success. In any event, a sleep appliance provided by a dentist must be prescribed by a sleep physician and ideally be provided by a dentist who is specially training in dental sleep medicine.

The Truth about Dental Insurance
Originally posted by my colleague Dr. Mac Lee on October 4, 2011.

Forty years ago, dental insurance benefits averaged $1,000, which was the equivalent of around $8,000 today. Here is the kicker; the average insurance plan is still close to $1,000. The purpose of this article is to explain the facts and fiction of what everyone calls “dental insurance.”

Fiction: You have a major medical problem, which includes surgery and hospitalization. You expect your insurance to take care of the major expenses after the deductible, and it does so. You would think dental insurance works the same way, but it doesn’t. Just calling it insurance is complete and total fiction.

Fact: People who think they have dental insurance really only have limited and restricted benefits that are controlled by an insurance company. A dental benefit is more like a coupon. It is only worth what the insurance company says its worth. It has nothing to do with what the dentist charges.

Fiction: To believe these two statements are true “My dental insurance will pay for it,” or “My dental insurance will pay 80 percent” is, in fact, fiction.

Fact: $1,000 was a lot of money when I graduated from dental school in 1972. That year, we bought a brand new Buick for $3,000. My crown fees were $250 and the insurance company paid well. Basically, a patient could get two or three crowns a year on old broken down, filled teeth and in a few years, their mouth was fixed. Plus, the patient could get two cleanings a year and not even max out their insurance. It was a great deal for patients and dentists.

If benefits kept up with inflation and raised the benefit ceiling each and every year with today’s benefit close to $8,000, people would still have a good deal. As it is, today’s crown price for one tooth will basically wipe out a year’s benefit. Not only that, the insurance company (yep, the one with the skyscrapers in New York, Chicago and San Francisco) often goes out of its way to deny your benefits.

Fact: Today’s dentistry is nothing like it was 40 years ago. If patients had problems, the choices were to pull, fill or crown. Today’s dentistry serves the patients with some of the most advanced, pain-free techniques in medicine. These procedures are not even covered by the dental benefit contract, or the procedures cost more than the paltry yearly benefit.

Back then, there was no such thing as Managed Care. Today’s insurance companies want you to choose a dentist based on cost and assume that all doctors are equally talented, knowledgeable, caring, ethical, available and personable – and that just isn’t true. The dentist making the deal with the insurance company may take a cut up to 30 to 50 percent. In order for them to stay in business, they have to see more people, do more procedures and cut costs in some manner. And even though it is a managed care system, dental benefits still acts as a coupon and not insurance.

Fiction: The dentist and dental team should understand a person’s dental benefit, what it will cover, pay, etc.

Fact: The contract is between the employer, employee and insurance company. The dentist has no role to play whatsoever; they are simply caught in the middle. Dentists, as a whole, are great people who love to help others. They try very hard to accommodate by hiring extra staff just to handle the paperwork, phone calls, etc., that insurance companies require.

Most important: Never let an impersonal insurance company dictate your dental care. They couldn’t care less about your health, comfort, peace of mind or appearance. Be happy you have that coupon for some dollars off, but never expect them to rebuild your burned-down house.

Mac Lee is a dentist in practice in Edna. He is the co-founder of Dentists Who Care, a national movement to educate the public on modern dentistry.
If you have any questions about your insurance feel free to contact our office at 1 613 376 6652 or visit our website at www. ClintonDentistry.com

I have had several parents over the last couple of years express the same frustration. Essentially they are frustrated by the fact that their children continue to get cavities despite their best efforts at prevention. Basically, decay is a nutritional disorder. One of the best articles describing the process was published in the Journal of General Dentistry by Dr. Ken Southward in the September/October 2011 issue, titled: The Systemic Theory of Dental Caries. It basically confirmed the findings of Dr. Weston Price and chronicled in his classic text Nutrition and Physical Degeneration first published in 1943 and in continuous print ever since. One of the frustrations of many parents is that their children continue to get cavities despite following what they feel is the Weston Price diet (and that as outlined in Ramiel Nagel’s book “Cure Tooth Decay”). The solution to the decay problem lies with diet and nutrition. Diet is a complex topic. Under ideal dietary conditions we get the nutrients we need to grow healthy tissues. Sadly, today’s food choices are difficult. A factory farm raised chicken does not nearly have the nutritional value as a free range ones we pick up at Sonset Farms, a small producer close to where we live. The chickens we get there are excellent and make a high quality broth. Sue even throws in the feet. The same can be said for every food choice, like eggs. You need to educate yourself on the quality of food you are buying. Your local Weston A. Price Chapter can help with helping you to source local foods. Look for a local chapter on line and get involved. The knowledge base in the membership of these organizations is truly amazing and you can usually connect with folks who are having similar issues. As a biological dentist I feel that the best dentistry is no dentistry. If I can educate patients or provide the resources to help them prevent dental problems that is the way to go.The benefits extend beyond preventing cavities to proper development of the the face and jaws, preventing orthodontic problems among many others.

So what do you do if your child is diagnosed with cavities? Well, it obviously is a wake up call to examine your child’s diet. Decay is a process. It can be active or inactive. To determine whether it is active or inactive you need reliable records that measure what is going on at two points in time. Xrays have been the traditional methods of assessment but a new technology using a non-invasive laser called the Canary System (www.thecanarysystem.com) has been shown to be more accurate than Xrays in detecting and monitoring decay. If early decay is detected preventative methods can be used to help reverse the process. Ideally, following many of the dietary principles of Weston Price is best but there are oral hygiene methods and topical solutions that can help. We like SHEC’s cavity guard (www.Shecs.com) that contains iodine versus fluoride. If teeth need to be restored with fillings we use a very non-invasive laser (www.lightwalkerlaser.com) to remove just the damaged tooth structure. Often the use of ‘freezing’ or local anesthetic is unnecessary. Other advantages of the laser is disinfection of the cavity and micro-etching of the tooth structure so the filling sticks really well. We will often use ozone to disinfect the cavity as well (www.oxygenhealingtherapies.com).

In any event, the best dentistry is no dentistry. Our knowledgeable team is always available to answer any questions you have.

Titanium has been used in dentistry as a restorative material for decades now. Most associate its use with frameworks for partial dentures and dental implants that replace roots. Now it is also being used to restore teeth as a material used in the fabrication of crowns.

The following is taken from a recent publication, the Journal of Prosthodontics, a peer reviewed scientific dental journal. For those with pre-existing sensitivities to metals, including nickle, and auto immune disorders Dr. Valentine-Thon suggests avoiding titanium implants. Testing, as mentioned in the article, is available for those considering titanium implants and restorations. Always discuss material selection with your dentist. Non-metal solutions are now available including ceramic implants. Also, as noted in the following article, if you have titanium implants fluoride should NOT be used.

Titanium and Allergic reactions

New research puts a question mark on conventional thinking that titanium (Ti) is unlikely to cause allergic reactions because of its superior corrosion resistance.

The incidence of allergic reactions attributed to titanium sensitization may increase with its overall medical use, research published in the Feb. 4, 2014 online edition of the Journal of Prosthodontics reported.

Scientists in Japan described the case of a 33-year-old woman referred for treatment following a 10-year history of eczema and itchy redness on her fingers. An allergy clinic conducted lymphocyte stimulation testing (LST), which has been demonstrated in the literature to be a reliable method for detecting metal sensitivity. The patient showed a rare, specific reaction to mercury, nickel and silver, but no reaction to other tested metals, including titanium.

After checking the composition of the patient’s 17 metal restorations, researchers removed all of those containing mercury or silver. The patient’s pruritus improved within two months. After waiting an additional month, researchers replaced the restorations with new ones made of titanium.

Nine months after placement of the Ti restorations, the patient developed cervical eczema. The condition gradually worsened. LST testing revealed a specific reaction to titanium, so the authors removed all titanium containing restorations and replaced them with auto-polymerizing poly (methyl methacrylate) resin. The patient’s eczema resolved within three months and didn’t reoccur over more than five years of observation.

Earlier research uncovered Ti allergy because dermal inflammatory conditions ceased after removal of titanium. This current study, however, described a case of dermatitis associated with a positive LST reaction to titanium after insertion of titanium dental restorations.

In discussion, the authors noted that Ti ions dissolve in artificial bio-liquids more than expected when the surface film is destroyed, and topical fluoride solutions can cause stress corrosion cracking.

“The present findings suggest that the patient had become sensitized by nine months after insertion of Ti, and the fact that complete remission was achieved after removal of the Ti strongly suggests that the cervical eczema was caused by an allergy to intraoral Ti,” the authors said.

They speculated that titanium restorations are likely to increase in frequency as a substitute for precious metal due to the belief that titanium is very stable.

“It seems likely that the incidence of allergic reactions caused by sensitization to titanium will increase in the future as use of medical titanium increases,” authors said. “The rare occurrence of such a response to titanium materials in clinical dentistry should therefore be further discussed and investigated.”

Excellent article on how we determine what materials to fix teeth with. We get asked a lot about this subject and this article can help those navigate all the information on this subject. We use materials that are bio-compatible for most folks meaning metal free ceramics, zirconium and resins. We still use titanium implants but are trained to place zirconium implants also. For those who really want to know what is best for them the tests mentioned are available through our office.

Identification and treatment of pathogenic bacteria, parasites and protozoa is fundamental to the improvement of health of the ‘gums’ or periodontal tissues. Recent tests that examine the nature of the microflora of the mouth seek to identify and provide solutions to eliminate periodontal disease, which is linked to many systemic diseases.

Testing of saliva and scrapings of plaque from areas of the mouth are the basis of two laboratory tests, OralDNA and OraVital. These can confirm the chairside evaluation of plaque using a phase contrast microscope, which is an immediate and visual representation of the patient’s oral microbiology, which can include parasites (amoebae, Trichanomas Tenax), fungi, spirochetes and much more. For an eye opening discussion of Biological Periodontal therapy have a look at the following interview with Dr. Lyons.

Recently had a query as to whether the exposed metal on a dental crown constitutes a health risk. The short answer is that probably does not, at least no more so than if it was not exposed.You see a common dental crown has a metal substructure that covers over the remaining tooth. That metal substructure is then covered with porcelain to look like a tooth. However, whether or not the metal is totally covered makes no difference, it is still exposed either from inside or outside of the tooth. Also a porcelain-fused-to-metal crown (PFM for short) can have up to 6 different metals to create an alloy that enables the porcelain to stick to it. The photo attached shows a typical PFM crown (second tooth in from the right – the PFM crown has exposed metal on the inside near the gum area at the top of the photo. The photo also shows badly broken down mercury and plastic fillings on the other teeth).

There are really two issues that the question raises:

1. What materials are in my mouth? and

2. Are they ‘safe’ in the sense are they affecting my health?

There is a lot of controversy with the safety issue of dental materials, particularly mercury fillings. Indeed, a recently published Canadian Mercury Amalgam Risk Assessment showed that 80.4% of Canadians with mercury fillings experience a daily dose of mercury that exceeds the REL(reference exposure level) associated dose. (Canadian Health Measures Survey: 2007-2009).

Many patients are asking for materials that are considered safe for them. Some choose to have biocompatability testing done by Cliffords Consulting (www.ccrlab.com). There are other tests available to test the various dental implant materials. For those interested in determining if mercury is an issue the best test is the Quicksilver Scientific Mercury Tri-test (www.QuicksilverScientific.com). Test kits are available at our office. Call if you want more information.

With regard to the materials used for crowns. There are metal-free ceramic and zirconia materials that not only look great but are very strong. See the before and after photos below.

Please feel free to contact us at info@ClintonDentistry.com or on our Facebook page. if you wish to speak with a real person call 613 376 6652.

This YouTube video is for all those parents whose children I have seen recently and who are wondering why their children have crowded teeth. This video explains one of the causes of crowding, that being poor breathing patterns or habits. If these patterns are not addressed before correction of the crooked teeth, the result may not be stable and relapse will occur. Enjoy another YouTube video from my colleague Dr. Scott Tamara.